/
March 2016 INFECTIOUS DISEASES March 2016 INFECTIOUS DISEASES

March 2016 INFECTIOUS DISEASES - PowerPoint Presentation

obrien
obrien . @obrien
Follow
342 views
Uploaded On 2022-06-15

March 2016 INFECTIOUS DISEASES - PPT Presentation

To identify of signs and symptoms of infectious diseases through screening and assessment To understand the rationale for regular screening for infectious diseases To describe appropriate care plans which include prevention and treatment for both substance misuse and infection ID: 918830

treatment hepatitis drug injecting hepatitis treatment injecting drug nice liver blood infection hiv health vaccine symptoms guidance substance org

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "March 2016 INFECTIOUS DISEASES" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

March 2016

INFECTIOUS DISEASES

Slide2

To identify of signs and symptoms of infectious diseases through screening and assessment To understand the rationale for regular screening for infectious diseases

To describe appropriate care plans which include prevention and treatment for both substance misuse and infectionLEARNING OUTCOMES

Slide3

Substance misuse is associated with infectious diseasesLevels of infection in injecting substance misusers is high

ie ~ 50%Life style and mode of use of substances are the main ‘causes’Substances can predispose to infection by lowering immunity or specific local effectsInfectious disease risk is related to the mode of use rather than specific substancesAssessment of drug users for risk behaviour and infectious diseases

CONTEXT

Slide4

Hepatitis B and C are major causes of liver disease and liver cancer20-25% of people with chronic hepatitis B have progressive liver disease which leads to cirrhosis in some cases

Over 90% people with hepatitis C have a history of injecting15-20% people with hepatitis C will develop liver cirrhosis after 20 years and 5% of those will develop liver cancerHepatitis C is the commonest indication for transplantation214000 are chronically infected with hepatitis C 2.2% of all people being seen for care in the UK have HIV

Slide5

Individuals put themselves at risk due to chaotic lifestyle and effect of substancesDrug users who are having sex without protection and sharing injecting equipment or

paraphenalia are at risk of contracting BBV (blood borne viruses eg hepatitis B and C, and HIV)Patients who misuse substances are likely to be susceptible to tuberculosis (TB)Drinking alcohol – especially binge drinking – and ‘club drugs’ alter judgement and impair decisions about sex and other drug use, leading to unprotected sex and sharing of injecting equipment

DISTINCTIVE FEATURES

Slide6

Substance misusers may view BBV as ‘occupational’ hazards of drug use Drug users may not recognise or differentiate the symptoms of BBV from intoxication, withdrawal or poor self care

Drug users may think the symptoms derive from impurities in street drugsPatients may present late to services and be less compliant with the medication prescribedBARRIERS TO DETECTION

Slide7

Infections may be viral, acute bacterial and sexually transmittedHistory taking should elicit information about behaviours that may have put the patient at risk

Injecting, unprotected sex and receiving a blood transfusion in other countriesInformation about those with whom the patients has had intimate or prolonged contactContact tracing may need to take placeASSESSMENT

Slide8

Common where water supplies and sewage disposal are poorPersonal and food hygiene are poor

Living in poor conditions, in crowded accommodation where this is no running water or adequate sewage eg hostels, squatsBlood to blood spread through needle sharing Transmission is by fecal and oral routesSymptoms may last for a week or more and include: flu type symptoms, nausea, stomach ache and diarrhoea, jaundice

HEPATITIS A

Slide9

Hepatitis B causes liver inflammation and fibrosisUntreated can lead to cirrhosis and liver failure or hepatocellular cancer

2% cause chronic hepatitisInformation about initiation of injecting, sharing of injecting equipment, frequency of sharing, number and type of contacts who may have been injectingHepatitis B is notifiable to Public health EnglandTransmission is by injecting, sexual contact and mother to babyHEPATITIS B

Slide10

A mild flu like feverTirednessAching limbs or joints

Loss of appetiteFeeling sick or vomitingReluctance to drink alcohol or smokeJaundice, itchy skin and dark urineHEPATITIS B - SYMPTOMS

Slide11

Many individuals with hepatitis C are abusing alcohol 50% lead to cirrhosis, chronic hepatitis and hepatocellular cancer

Transmission is via injecting, sexual contact, mother to child at birthIn 40% cases infected individuals cannot identify a source for their infectionCocaine can damage the inside of the noe leading to bleeding Inhalation of contaminated blood may lead to infectionSharing items eg toothbrushes, razors, scissors and blood products may spread infection

No vaccine is availableHEPATITIS C

Slide12

Flu like symptomsMild to severe fatigue

AnxietyWeight lossLoss if appetiteInability to tolerate alcoholDiscomfort over liver areaProblems with concentrationNauseaJaundice

HEPATITIS C - SIGNS AND SYMPTOMS

Slide13

Antibody test – proteins made by the body to respond to the virusPolymerase chain reaction (PCR) or viral RNA tests – identify the presence of the virus

Liver function test to identify the impact on the liverLiver biopsy to assess severity of damage from chronic hepatitis CHEPATITIS C - TESTS

Slide14

Flu like illness a few weeks after infection with HIV – 80% casesSymptoms indicate that the body is responding to the infection

Symptoms are non-specific History should try to establish risks associated with unprotected sex, sex with bisexual men, sharing injecting equipment or paraphernaliaTransmission is via injecting, sexual contact, blood including menstrual blood, mother to baby before during or after birth during breast feedingHIV cannot be transmitted through saliva, sweat, tears, feces and urine

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Slide15

FeverSore throatBody rash

TirednessJoint painMuscle painSwollen glandsTests on blood are very reliable and provide a result from 4 weeks after possible infectionTreatment is very successful with anti retroviral treatment

HIV – SYMPTOMS, TESTS AND TREATMENT

Slide16

Transmission is via injectionStaphylococcus and streptococcus are the agentsEndocarditis – fever, heart murmur, peripheral stigmata

Necrotising fasciitis – pain out of proportion with clinical findingsBotulism: scratchy throat, cranial nerve palsies and paralysisANTIBACTERIAL INFECTION

Slide17

Risk factors include:Smoking cigarettes, other serious illnesses (hear disease, liver cirrhosis), immune system problems (cancer treatment, HIV/AIDS, organ transplant)

Symptoms: FeverCough with yellow, green or blood tinged mucousChest pain the worsens when coughing or breathingSudden onset of chillsHeadache and muscle painsRESPIRATORY INFECTIONS - PNEUMONIA

Slide18

Food, saliva, liquids or vomit is breathed into the lungs or airways after alcohol consumption or overdoseSymptoms include: bluish skin discolouration

Chest painCoughing up foul smelling sputum FatigueFeverShortness of breathWheezingExcessive sweting

ASPIRATION PNEUMONIA

Slide19

Listen for abnormal chest soundsTake blood sample to get a white cell count. A high count usually indicates infection

Take blood or mucous samples to identify infection causing pathogenOrder chest x rays to confirm the presence and extent of infectionASPIRATION PNEUMONIA - DIAGNOSIS

Slide20

Early detection makes it easier to treat with antibiotic combination therapy for 6 months: drug users might find compliance a problem

Signs and symptoms include: persistent feverHeavy sweating at nightLoss of appetiteUnexplained weight lossGeneral and unusual sense of tirednessHaemoptysisRecent contact with someone who has TB

TUBERCULOSIS

Slide21

Frequently asymptomaticNeed regular screening for detectionAll associated with morbidity if left untreated

SyphylisChlamydiaGonorrhoeaHPV – human papilloma virusSEXUALLY TRANSMITTED DISEASES

Slide22

Vaccine is availableConsider single dose or combined vaccine – depends on whether the patient is likely to return for a subsequent dose

One dose of single vaccine confers greater protection against Hep A than one dose of the combined Hep A Hep B vaccine Vaccinate all injecting drug users against Hep ASingle component preferable to combined Hep A and Hep B vaccineFor single vaccine give 2 doses with second dose after 6-12 monthsSecond dose may be delayed for up to 3 years

TREATMENT – HEPATITIS A

Slide23

Most people with acute hepatitis recover without treatment within 4-12 weeks2% cause chronic hepatitis which can lead to cirrhosis and hepatocellular cancer

Can be treated with antiretroviral drugsA vaccine is availableVaccinate all drug users against Hepatitis B – non-injectors may become injectorsHEPATITIS B

Slide24

No need to carry out pre vaccination testingUse accelerated 0, 7 and 21 day schedule to aim to complete the course quickly.

Incomplete vaccination offers some protection but completing the course is recommendedOffer vaccination to partners and childrenHEPATITIS B

Slide25

Treatment can eradicate infection in 40-80% of infected individualsAntiviral treatment consists of self administered weekly subcutaneous injections of pegylated interferon and twice daily oral ribavirin for 24-48 weeks

No vaccine is availableSubstance misusers will need to persevere as treatment is intensiveThey need to be detoxified or stable on substitute medication and abstinent from other drugsInjecting the antiviral medication may lead to relapse to (injecting) drug use

HEPATITIS C

Slide26

If patients continue to drink while taking medication there is a high risk of liver damageRegular blood tests required to check on liver function

Patients with HIV or hepatitis will need regular liver function testsAntiretroviral medication taken together with TB treatment may have side effects and interactions requiring careful monitoringTreatment can last for 6-12 months so some patients may drop out and need assertive outreach approaches to re-engage A vaccine is available

TUBERCULOSIS

Slide27

HIV: Antiretroviral treatment is successful; no vaccine is available Acute bacterial infections: Staphylococcus and streptococcus can be treated with identification of source and antibiotics

Sexually transmitted infections all associated with long term morbidity if left untreatedChlamydia and gonorrhoea: antibiotics but some strains are resistantSyphylis: penicillin is preferred treatment; early treatment is crucialGenital herpes: antiviral medication; no cure; can flare up

HIV, ACUTE BACTERIAL INFECTIONS

Slide28

Specialist advice should be sought from e.g. sexually transmitted disease clinic (STD), specialist chest clinic

The GP and services should liaise regularly to ensure screening and effective treatmentSpecialists working in primary care, chest clinics and STD services should contact specialist addiction services to arrange access and management of substance problemsREFERRAL, NETWORKS AND SERVICES

Slide29

If patients are reluctant to stop or reduce their drug use, preventative measures should be discussed and implemented to contain infection risks and spreadAdvice on safer injecting, use of sterile equipment , and risks of diseases should be given

If patients continue to inject, clean needles and syringes should be obtainedPrevention of BBV has many benefits including reducing health harms by those who use substancesHINTS &TIPS

Slide30

Needle and syringe programmesComprehensive protocols to raise awareness of risks of BBV: promotion of testing, deliver vaccination and access pathways into treatment

Provision of advice and materials to reduce harm from injecting drug useOffers of testing and vaccination to all those at riskPrevention of uptake of injecting drug use and promote switching from injecting to other routesImplementation of workforce and occupational health interventions for people working with those at risk of contracting BBV

PREVENTION

Slide31

Findings (2014) Drug Matrix cell D1: Organisational functioning; Reducing harm

http://findings.org.uk/count/downloads/download.php?file=Matrix%2FDrugs%2FD1.htmHealth Protection Agency (2015) Hepatitis C in the UK. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448710/NEW_FINAL_HCV_2015_IN_THE_UK_REPORT_28072015_v2.pdf

Health Protection Agency (2014) Shooting Up Infections among injecting drug users in the UK 2013. An update: November 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/370707/Shooting_Up_2014.pdfHealth Protection Agency (2013) Substance misuse and TB: Information for key workers (care workers, social workers, project workers and health professionals) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/466947/NKS_Substance_misuse_and_TB_Information_for_key_workers_.

pdfJones D. R. et al, (2004) Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services, 55 pp1250-1257National Knowledge Service - TB: http://www.neli.org.uk/IntegratedCRD.nsf/e67b3914fbe8da658025755c0062cd62/45aa03ceba2bc98080257145003ace45?OpenDocument&Highlight=0,TB

NICE

(2004) Hepatitis C - pegylated interferons, ribavirin and alfa interferon (NICE technology appraisal,TA75)

http://

guidance.nice.org.uk/TA75

This

guidance replaces Hepatitis C - alpha interferon and ribavirin (TA14). This guidance is extended by Hepatitis C -

peginterferon

alfa and ribavirin (TA106).

http://

guidance.nice.org.uk/TA75

References

Slide32

NICE (2014) Needle and syringe programmes: NICE public health guidance 52 guidance. http://www.nice.org.uk/guidance/ph52

NICE (2006) Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a (NICE technology appraisal,TA96) http://guidance.nice.org.uk/TA96

NICE (2010) Hepatitis C - peginterferon alfa and ribavirin (NICE technology appraisal,TA200) http://guidance.nice.org.uk/TA200Public Health England (2015) Hepatitis C in the UK: 2015 report. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448710/NEW_FINAL_HCV_2015_IN_THE_UK_REPORT_28072015_v2.pdf Public Health England:

https://www.gov.uk/topic/health-protection/infectious-diseasesRaoult D., Foucalt, C., Brouqui P.(2001) Infections in the homeless. The Lancet Infectious Diseases Vol 1(2) September pp77-84Tetrault, J M,

Fiellin

, D A, and Sullivan L E (2010) Substance Abuse and HIV:

Treatment Challenges

Substance Abuse and HIV: Treatment. The AIDS Reader. August 13, pp1-8

Wiessing

, L.,

Ferri

, M., Grady, B.,

Kantzanou

, M.,

Sperle

, I., Cullen, K.,

Hatzakis

, A.,

Prins

, M., Vickerman, P., Lazarus, J.V., Hope, V.,

Matheï

, C. (2014) ‘Hepatitis C virus infection epidemiology among people who inject drugs in Europe – A systematic review of data for scaling up treatment and prevention’,

PLoS

ONE 9(7): e103345. doi:10.1371/journal.pone.0103345

World Hepatitis Alliance

http://www.worldhepatitisalliance.org

/

References